Breastfeeding Rates Increase But Racial Gaps Persist Interview with:

Dr. Erica H. Anstey PhD Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion  Immunization Services Division National Center for Immunization and Respiratory Diseases CDC

Dr. Anstey

Dr. Erica H. Anstey PhD
Division of Nutrition, Physical Activity and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Immunization Services Division
National Center for Immunization and Respiratory Diseases
CDC What is the background for this study?

Response: The American Academy of Pediatrics (AAP) recommends that infants are breastfed exclusively for about the first 6 months and that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. Although breastfeeding initiation and duration rates have increased overall in the United States, breastfeeding rates vary by geographic location, socioeconomic, and race/ethnic groups. Breastfeeding initiation and duration have been historically and consistently lower among black infants compared with white and Hispanic infants.

There are many factors that influence a woman’s decision to start and continue breastfeeding. These include knowledge about breastfeeding, cultural and social norms, family and social support, and work and childcare environments. Some barriers to breastfeeding are disproportionately experienced by black women, including earlier return to work, inadequate receipt of breastfeeding information from providers, and lack of access to professional breastfeeding support. What are the main findings?

Response:  The National Immunization Survey tracks national estimates of breastfeeding initiation, duration, and exclusivity. We analyzed these data to describe differences in breastfeeding initiation, exclusivity through 6 months and duration at 12 months among black and white infants born in 2010-2013, at the state-level (NIS survey years 2011-2015). Most of the 34 states included in the study reported lower rates of breastfeeding initiation among black infants compared to white infants. In 14 states (primarily in the South and Midwest) the percent of black infants who ever breastfed was at least 15 percentage points lower than white infants. A significant difference of at least 10 percentage points was found between black and white infants for 6 months exclusive breastfeeding and 12 months breastfeeding in 12 and 22 states, respectively. What should clinicians and patients take away from your report?

Response: Despite overall increases in breastfeeding rates for black and white infants in the United States over the last decade, a racial gap persists – particularly in the South and the Midwest. Additionally, while nationally the rate of breastfeeding initiation is high (~80%), rates of breastfeeding initiation vary by state and racial/ethnic group, with several states, particularly in the south, having rates of breastfeeding initiation <50% among black infants. What recommendations do you have for future research as a result of this study?

Response: Breastfeeding rates have been increasing overall, among all racial/ethnic groups; however, we need to better understand why some states have such large disparities in breastfeeding rates between black and white infants so that public health efforts to improve breastfeeding rates among black infants are effective. Because the racial disparity in breastfeeding might depend on factors such as income and education, future studies examining the interactions among these factors are warranted to understand the independent contribution of each factor. In addition, proven interventions to support breastfeeding for black women are needed. Is there anything else you would like to add?

Response: The positive impact of breastfeeding on short-term and long-term health outcomes of both mothers and their infants is well-documented. Breast milk is the most complete form of nutrition for infants and protects infants from many diseases including diabetes, diarrhea, ear infections, respiratory infections, and Sudden Infant Death Syndrome. Breastfeeding also lowers the risk of breast and ovarian cancers, type 2 diabetes, and heart disease for mothers. Thus, it is important for all mothers to receive the support they need to breastfeed their infants. Many mothers need ongoing community support to help them overcome challenges they face while in the hospital, when they go home, or after they return to work.  To increase the rate of breastfeeding among black infants, interventions are needed to address barriers experienced disproportionately by black mothers.  No disclosures. Thank you for your contribution to the community.


Anstey EH, Chen J, Elam-Evans LD, Perrine CG. Racial and Geographic Differences in Breastfeeding — United States, 2011–2015. MMWR Morb Mortal Wkly Rep 2017;66:723–727. DOI:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.



Last Updated on July 17, 2017 by Marie Benz MD FAAD